A New Check for Heart Problems

Health Matters: A test for inflammation increasingly is being used to gauge patients' risk of cardiovascular disease

By

Laura Landro

Updated July 13, 2012 9:31 p.m. ET

After her mother unexpectedly died from a tear in the wall of her heart at age 63, Patricia Walters talked to her doctor, Leslie Cho, about how to better monitor her own heart health.

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Pregnant at the time with her own daughter, Ms. Walters, now 46, says she was "a nervous wreck" worrying that she, too, might face serious cardiac risk.

ENLARGE

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As part of an overall health evaluation after the pregnancy, Dr. Cho, director of the Women's Cardiovascular Center at the Cleveland Clinic, recommended a simple blood test called hs-CRP—for high sensitivity C-reactive protein, which is a marker for inflammation in the body.

Easily done at the same time as a cholesterol screening, and covered by most insurance, the test is increasingly being used as a routine screening tool for patients with one or two risk factors to help assess their heart-attack and stroke risk.

Greater Accuracy

The hs-CRP test is a newer, more sensitive version of a standard CRP check, and experts say it can more accurately detect lower concentrations of the protein, making it more useful in predicting a healthy person's risk for cardiovascular disease. It measures CRP in milligrams per liter of blood: less than 1.0 mg/l is considered low risk; 1.0 to 3.0 mg/l is average risk; and greater than 3.0 mg/l is considered high risk for cardiovascular disease.

The American Heart Association and the American College of Cardiology both have endorsed the use of hs-CRP for "intermediate risk" individuals. And one major study suggests that even people with minimal risk factors in their late 50s and early 60s should have the test.

ENLARGE

While inflammation is the body's natural response to a variety of physical states, including fever, injury and infection, research shows it also plays a role in a range of chronic illnesses, including cardiovascular disease. Inflammation of the arteries has been linked to heart attack, sudden death and stroke, Dr. Cho notes.

Those who smoke, have high blood pressure, and are overweight and sedentary tend to have high levels of CRP—and those who are thin and fit have lower levels. But genetic factors can also contribute to elevated CRP in people without traditional risk factors.

Research shows that elevated levels of CRP are at least as predictive of cardiac risk as cholesterol levels. A 1997 study of healthy physicians, published in the New England Journal of Medicine, was the first to show that relative risk of first heart attack or stroke was directly related to elevated CRP levels. And the Harvard Women's Health Study, which looked at 12 different markers of inflammation in healthy postmenopausal women, found that after three years CRP was the strongest predictor of risk.

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Not-So-Low Risk

While some experts don't think the hs-CRP test adds much to current cardiovascular risk-prediction strategies, others say a large study known as the Jupiter trial supports broad use of the test to find people who may assume their low cholesterol levels protect them from heart trouble—and determine whether they might be candidates for treatment with statin drugs. The 2008 study showed that in patients with low levels of LDL—the bad cholesterol—but high hs-CRP levels, the statin Crestor reduced the risk of heart-related death, heart attacks and other serious cardiac problems by 44% compared with those given placebos.

Paul Ridker, a Harvard University researcher who led the Jupiter study, says, "We know that those with elevated hs-CRP are at high risk even if cholesterol levels are low, and that statin therapy can reduce the risk of heart attack and stroke in this group." While the study showed inflammation contributes as much to cardiovascular risk as does high blood pressure or high cholesterol, Dr. Ridker says "the core research question now is whether or not reducing inflammation per se will reduce that risk."

His team has now launched two major clinical trials—one funded by the federal government and one by industry—to address that question. (Dr. Ridker is co-inventor on patents held by Brigham and Women's Hospital related to the use of inflammatory biomarkers including hs-CRP in evaluating risk for cardiovascular disease.)

Something to Talk About

Dr. Cho at the Cleveland Clinic says the test can help identify those patients at intermediate risk and open the discussion about prevention and treatment.

"If you are 53 and chubby with high blood pressure and borderline high cholesterol but your CRP is normal, I'm not sure I would throw the whole kitchen sink at you," says Dr. Cho. "But if your CRP was elevated, I would want to talk to you about the Jupiter results" and discuss starting a statin. She also counsels patients with elevated levels about lifestyle changes including weight loss, nutrition and exercise.

Ms. Walters didn't have high levels when she was first tested, but they began to rise in later screenings. She now takes a statin and has her blood monitored regularly. She also joined Weight Watchers to drop a few pounds and runs with friends for exercise.

A former teacher who is now a stay-at-home mom, Ms. Walters says, "I have a little girl, and I plan to be here for everything."

Ms. Landro is an assistant managing editor for The Wall Street Journal and writes the paper's Informed Patient column. She can be reached at next@wsj.com.

Corrections & Amplifications Patricia Walters had an hs-CRP test following her pregnancy. An earlier version of this article incorrectly implied that she had the test while pregnant.

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